Provider Demographics
NPI:1932293156
Name:BRADCO INC
Entity Type:Organization
Organization Name:BRADCO INC
Other - Org Name:CHANDLER NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RISING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-258-1131
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:OK
Mailing Address - Zip Code:74834-0429
Mailing Address - Country:US
Mailing Address - Phone:405-258-1131
Mailing Address - Fax:405-258-5023
Practice Address - Street 1:601 W 1ST ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-2441
Practice Address - Country:US
Practice Address - Phone:405-258-1131
Practice Address - Fax:405-258-5023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH41024102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100776610AMedicaid
OK100776610AMedicaid